Provider Demographics
NPI:1811051899
Name:SPANO, GINA LEE (RD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LEE
Last Name:SPANO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:L
Other - Last Name:SPANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:2025 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2115
Mailing Address - Country:US
Mailing Address - Phone:916-973-6297
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-6297
Practice Address - Fax:916-973-6943
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA723656133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered